In the recent past, women's participation in athletics has become much more common. One of the biggest reasons for this surge was the passage of legislation in 1972 called Title IX. This legislation essentially states that high school and colleges must provide equal opportunities in athletics for both men and women. This includes equality in all areas such as participation, scholarship, dollars, and athletic benefits. Since 1972 there has been a huge increase in the number of women participating in college and high school athletics, however we have seen a great increase in other areas as well. This is true in the areas of Olympic and professional sports. There has also been an increase in the number of people in our society who are interested in lifetime fitness and this includes a large number of female participants. This increase in girls and women in athletics has brought about a better awareness and understanding of the issues that are unique to the female. THE FEMALE ATHLETE TRIAD: This is a term that was coined by the American College of Sports Medicine (ACSM) in 1992 because of the increase in incidence and awareness of three disorders of the female athlete. This triad of disorders which are often interrelated include: disordered eating, amenorrhea, and osteoporosis. In 1997, the ACSM published a position stand on this topic and includes the following statements: 1) The Female Athlete Triad is a serious syndrome consisting of disordered eating, amenorrhea, and osteoporosis. The components of the Triad are interrelated in etiology, pathogenesis, and consequences. Because of the recent definition of the Triad, prevalence studies have not yet been completed. However, it occurs not only in elite athletes but also in physically active girls and women participating in a wide range of physical activities. The Triad can result in declining physical performance, as well as medical and psychological morbidity's and mortality. 2) Internal and external pressures placed on girls and women to achieve or maintain unrealistically low body weight underlies the development of these disorders. 3) The Triad is often denied, not recognized, and under reported. Sports medicine professionals need to be aware of the interrelated pathogenesis and the varied presentation of components of the Triad. They should be able to recognize, diagnose, and treat or refer women with any one component of the Triad. 4) Women with one component of the Triad should be screened for the other components. Screening for the Triad can be done at the time of the preparticipation examination and during clinical evaluation of the following: menstrual change, disordered eating patterns, weight change, cardiac arrhythmias including bradycardia, depression, or stress fracture. 5) All sports medicine professionals, including coaches and trainers, should learn about preventing and recognizing the symptoms and risks of the Triad. All individuals working with active girls and women should participate in athletic training that is medically and psychologically sound. They should avoid pressuring girls and women about losing weight. They should know basic nutrition information and have referral sources for nutritional counseling and medical and mental health evaluation. 6) Parents should avoid pressuring their daughters to diet and lose weight. Parents should be educated about the warning signs of the Triad and initiate medical care for their daughters if signs are present. 7) Sports medicine professionals, athletic administrators, and officials of sport governing bodies share a responsibility to prevent, recognize, and treat the Triad. The sport governing bodies should work toward offering opportunities for educational programs for coaches to educate them and to lead them toward professional certification. They should work toward developing programs to monitor coaches and others to ensure safe training practices. 8) Physically active girls and women should be educated about proper nutrition, safe training practices, and the warning signs and risks of the Triad. They should be referred for medical evaluation at the first sign of any of the components of the Triad. 9) Further research is needed into the prevalence, causes, prevention, treatment, and sequelae of the Triad.
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